Laser‐assisted microvascular anastomosis using CO₂ and KTP/532 lasers

Abstract

The milliwatt carbon dioxide (CO2) laser has been shown to be an effective device for performing laser-assisted microvascular anastomosis (LAMA) with consistently high patency rates, minimal tissue disruption, and rapid surgical time as well as the potential for reduced inflammation due to fewer foreign bodies (sutures) in the wound. The purpose of this investigation was to determine the feasibility of using the potassium titanyl phosphate (KTP) laser to perform LAMA and to compare it to CO2 LAMA in both arteries and veins. Patency rates, inflammatory response, and course of healing were evaluated through histological analysis. Twenty-eight rats were divided into two groups, which underwent either CO2 or KTP LAMA and then were sacrificed at 3 days, and 1, 2, 4, 8, and 12 weeks postoperatively. Patency rates for arteries and veins were comparable for both wavelengths (CO2: 100% for arteries, 93% for veins; KTP: 93% for arteries, 93% for veins). Histological grading of inflammation and fibrosis showed no significant difference between the two groups. This study demonstrated the efficacy of using the KTP/532 laser in performing LAMA. We found the KTP and CO2 LAMA to have comparable patterns of tissue damage and course of healing. Although this experiment did not investigate the mechanism(s) of tissue welding, our results suggest that successful LAMA may be independent of wavelength.

Microarterial anastomosis using a noncontact diode laser versus a control study

“…Using a long irradiation time, they try to concentrate the conversion of laser light to heat in the target tissue [19, 201. In fact, moderate irradiance of 700 W/cm2 and exposure time of 4.5 s facilitate slight and progressive collagen denaturation of the media and adventitia, inducing a good sealing effect [ll, 22, 231. Despite an important beam divergence (numerical aperture 0.22), the diode beam is transmitted through a micromanipulator. This delivery system, being microscope mounted, has the ability to provide milliwatt power as well as a spot size of reduced diameter (300 p.m) comparable to that obtained by the other sources of laser [16]. Our study presents an original procedure of microanastomoses with simultaneous control performed by the same operator in the same animal, one common carotid being submitted to diode laser anastomosis and the other one to manual suturing.…”

Comparative In Vitro Study of Tissue Welding Using a 808 nm Diode Laser and a Ho:YAG Laser

“…Even though the welding process is not fully understood, it is supposed that tissue heating leads to coagulation of proteins and therefore to an anastomotic bond of the vessel stumps [1,2]. Several investigators showed the possibility to successfully weld blood vessels using various laser systems but often with insu$cient stability [3][4][5][6][7][8][9][10][11][12][13]. Therefore, some authors used additional stabilisation sutures to fix the vessels during the laser procedure [14][15][16].…”

Open Guide Suture Technique for Safe Microvascular Anastomosis

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] The application of a meticulous surgical technique that allows completely clear visualization and procedure in each is obviously of great importance in reducing vascular occlusive complications. Therefore, every effort should be made to perform anastomosis without any doubtful steps or in a blind fashion.…”